Provider Demographics
NPI:1598158958
Name:GAGA PHARMACY INC
Entity Type:Organization
Organization Name:GAGA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANG
Authorized Official - Middle Name:YAN
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-699-6666
Mailing Address - Street 1:9005 CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4046
Mailing Address - Country:US
Mailing Address - Phone:718-699-6666
Mailing Address - Fax:718-592-8899
Practice Address - Street 1:9005 CORONA AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4046
Practice Address - Country:US
Practice Address - Phone:718-699-6666
Practice Address - Fax:718-592-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7390870001Medicare NSC